Sprain, Strain or Something More

With Dr. Luke McKenna
 
Your child limps off the field, or grabs a wrist after a bad landing. Most of the time you're right to call it a sprain, ice it, and move on. I've spent years working with young athletes in Florida and Virginia, from weekend rec to MLB/NFL/NHL players, and the sprains aren't what worry me. What worries me is the six-week ache nobody mentioned because it "wasn't that bad."
 
A child's skeleton isn't a small adult skeleton. There are growth plates near the ends of the bones, and mechanically they're the weakest point in the system, weaker than the ligaments and tendons around them. So an injury that would strain an adult's muscle can instead land on a child's growth plate, and it often doesn't swell or bruise. It just aches a little more each week.

Routine Injuries
 
Sprains and strains still make up most of the injuries I see. Rest it, ice it fifteen to twenty minutes a few times a day, wrap it, elevate it, ibuprofen if appropriate. Most improve over a week or two. The mistake I see isn't the first few days, it's the comeback: sending a child from the couch straight back into a scrimmage instead of easing in.
 
Get it looked at sooner if they can't bear weight, if there was a pop at the moment of injury, if the joint feels unstable, if there's real swelling or numbness, or if two weeks pass with no improvement.
 
The ones that don't announce themselves
 
These build quietly and the first sign is often performance, not pain. A pitcher losing velocity. A gymnast avoiding one specific move. By the time it hurts enough to complain about, it's usually been going on a while.
 
Low back pain: In a gymnast, diver, football player, weightlifter, dancer, or volleyball player, don't wave this off. Spondylolysis, a stress fracture in a small bony bridge in the spine, is the single most common cause of low back pain in teenage athletes who show up in a sports clinic. It aches, gets worse with activity and with arching backward, eases with rest, and lingers for weeks. Caught early, it heals well and children go back to their sport. Ignored, it can occasionally progress to a vertebra slipping and that isn't a toughing-it-out injury, but a season ender.
 
The throwing arm: Little League shoulder (usually ages 11-16) and Little League elbow (usually 9-13) come from the same overuse mechanism on a growth plate that isn't ready for it. Watch for shoulder or inner-elbow pain, and for a drop in velocity or accuracy before pain even shows up. Pitch count limits and several real months off throwing each year are the best prevention I know of.
 
Gymnast's wrist: Handsprings and vaults load a bent-back wrist over and over, and it can injure the growth plate of the forearm bone. This causes a nagging ache on the thumb side of the wrist. This must be allowed to heal fully, otherwise it will persist for as long as the athlete is active.
 
Apophysitis: This is the real name behind most "growing pains" in active 8-15 year olds, where a tendon keeps pulling on a growth center. Osgood-Schlatter (tender bump below the kneecap), Sinding-Larsen-Johansson (pain at the bottom of the kneecap), Sever disease (heel pain, extremely common in runners, soccer, basketball, gymnastics, dance). These are able to be diagnosed with a good physical exam, rarely need imaging, and are treated with relative rest, stretching, ice after activity, sometimes a heel cup. They resolve as children finish growing.
 
Bone stress injuries: These are the so-called overtraining injuries. Too much impact, not enough recovery, and bone weakens before it can rebuild. Pain builds at one specific spot, worse with activity, better with rest, mostly the lower leg and foot in runners and endurance athletes . Shin, foot, and hip locations are higher risk and need prompt attention. Recovery runs weeks to months, with a gradual, genuinely pain-free return.
 
Why this keeps happening
 
These injuries result from too much of one motion, too often, without enough recovery. Growing bone just doesn't handle repetitive stress the way adult bone does.
 
What can actually help prevent these are one or two days off organized sport each week, two to three months off any single sport per year, gradual increases in training load, taking early back/elbow/shoulder pain seriously, and playing more than one sport when you can instead of specializing young.
 
When to call
 
Back pain lasting more than a week or two, or worse with arching. Elbow or shoulder pain, or a throwing arm that's underperforming. Pain over one specific bony spot that worsens with activity. Anything not improving with rest, ice, and time. A limp, night pain, or pain interfering with daily life.
 
We don’t want to keep children off the field. We want them on it for years, not sidelined for a season because something small got ignored too long.